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NPI Code Detail

MEDICARE: ROBERT B CLARK MD

MEDICARE: ROBERT B CLARK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology PhysicianC5383AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538123518
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT B CLARK MD
Provider Business Mailing Address
First Line : PO BOX 65978
Second Line :
City : CHARLOTTE
State : NC
Zip : 28265-0978
Country : US
Telephone Number : 501-771-4693
Fax Number : 501-771-4885
Provider Business Practice Location Address
First Line : 1701 S SHACKLEFORD RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-4335
Country : US
Telephone Number : 501-219-7481
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 07/06/2010

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